Family practice
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Since the turn of the millennium, out-of-hours primary health care in The Netherlands has faced a substantial change from small locum groups towards large GP cooperatives. Improving the quality of care requires evaluation of patient satisfaction. ⋯ A reliable measure of patient satisfaction has been developed that can also be used for the comparison of GP cooperatives on an organizational level. Overall satisfaction was high, showing highest levels for home visit and lowest levels for telephone advice.
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Continuity is thought to be important to GPs but the values behind this are unknown. ⋯ Personal continuity may offer important benefits to doctors and patients, but we do not know how unique its values are. In particular, it is not clear whether the same benefits can be achieved within teams, the level at which continuity is increasingly being provided. The relative advantages and limits of the different means of delivering continuity need to be better understood, before further policy changes that affect personal continuity are introduced.
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Depression is the commonest mental health problem in elderly people and continues to be underdiagnosed and undertreated. ⋯ This study highlights the complicated nature of the diagnosis and management of late-life depression. Protocols for the diagnosis and treatment of depression emphasis the biomedical model which does not fit with the everyday experience of GPs or elderly patients who share the views of primary care professionals that depression is a consequence of social and contextual issues. There is a need for the development of evidence-based provision for older people with depression within primary care, but also a need for elderly patients to be made aware of the legitimacy of presenting low mood and misery to their primary care professional.
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Ethnic minority patients seem to be confronted with barriers when using health services. Yet, care providers are often oblivious to these barriers, although they may share to some extent the burden of responsibility for them. In order to enlighten care providers, as to the potential pitfalls that may exist, there is a need to explore the different factors in the creation of the barriers. ⋯ This review has the goal of raising awareness about the myriad of potential barriers, so that the problem of barriers to health care for different ethnic minorities becomes transparent. In conclusion, there are many different potential barriers of which some are tied to ethnic minorities. The barriers are all tied to the particular situation of the individual patient and subject to constant adjustment. In other words, generalizations should not be made.